Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification
BACKGROUND Practicing physicians rarely apply evidence-based medicine (EBM). Unlike their more-experienced counterparts, current residents probably participated in EBM curricula during medical school. The current study was designed to determine the extent to which they or their faculty spend time searching for evidence-based answers. This information will help guide the content and format of EBM curricula in residency programs. METHODS The method used was direct observation of 13 faculty and 25 residents combined with self-report. Number of clinical questions, sources consulted, search times, and satisfaction with answers were collected for clinical encounters. The setting was the University of California San Francisco-Fresno Family Practice Residency Program. RESULTS Participants asked 274 clinical questions over 215 patient encounters (1.3 per encounter). Residents generated 1.5 per encounter and faculty generated .8. The group sought immediate answers to 66% of questions, found satisfactory answers to 87% of these, and later pursued answers to only 6% of remaining questions. Most searches (66%) took less than 2 minutes. Physicians most commonly used another person or a pocket reference. CONCLUSIONS Residency physicians have clinical questions but rarely use evidence-based sources to answer them.